I. Overview
Gluteal epicutaneous nerve entrapment syndrome is also known as gluteal epicutaneous nerve injury, gluteal epicutaneous nerve entrapment, gluteal epicutaneous neuritis, and gluteal epicutaneous neuropathy. It is not uncommon to see low back, leg and hip pain syndromes caused by damage to the gluteal epicutaneous nerve.
Etiology and pathogenesis
The gluteal epicutaneous nerve originates from the posterior lateral branch of the lumbar 1 to 3 nerves, penetrates at the outer edge of the sacrospinous muscle, enters the subcutis through the lumbar dorsalis fascia, and crosses the iliac crest to distribute to the skin behind the buttocks. It is generally believed that the superior gluteal cutaneous nerve is secured by the lumbodorsal fascia with the bony fiber canal of the iliac crest stroke as it crosses the iliac crest into the gluteal region. Improper movement of the lumbar region causes the nerve to become stuck at the external opening of the fibrous canal of the iliac crest, or to be compressed by the surrounding scar tissue or fatty hernias, or to deviate from its normal travel position, resulting in stasis and edema of the nerve branch and the formation of striae, which is called “tendon out of the groove” in Chinese medicine. It has also been suggested through autopsy and clinical observation that there may be multiple points of entrapment of the superior gluteal cutaneous nerve during its course. Some of the epiglottic nerve entrapments are caused by small joint disorders in the upper lumbar segment, and the entrapment symptoms of the nerve branch can be relieved by manipulation or nerve block. The theory of multiple nerve entrapment suggests that nerve entrapment syndromes can arise from multiple compressions of the nerve trunk, even if each compression is insufficient to produce clinical symptoms, but together they may cause functional impairment. It is suggested that in clinical cases of nerve entrapment, attention should not only be paid to the human hip site of the nerve, but also to the possibility of other points of entrapment.
III. Clinical manifestations
1. Most people have a history of trauma to the lumbar and hip area and a history of feeling cold.
2. Pain in the lumbar and hip area may be stabbing, aching or tearing-like pain. There may be involvement pain toward the back of the thigh, but the pain is not more than the knee joint.
3.Some patients may have skin sensory disorder in the supra-gluteal region, restricted bending, inability to flex the hip or stand upright, and difficulty walking.
4. The pressure pain point is located 3-4 cm below the midpoint of the iliac crest, i.e. the point where the superior gluteal nerve enters the hip, with a fixed position, and there may be a radiating sensation to the lower hip and the posterior thigh.
5. The deep part of the pressure point can be touched by the muscle bundle of striated elevation, and chronic patients may have atrophy of the gluteal muscles.
6.Tension and spasm of the lumbar muscles and limitation of forward flexion of the lumbar region.
7.If the upper lumbar segment is palpated, the ligamentous ligaments of the upper lumbar segment may be deviated, the ligamentous ligaments of the upper lumbar segment may be peeled off, and the lateral pressure pain of the spinous process may be radiated to the buttocks.
8. Imaging examination: X-ray film has no specific performance.
IV. Differential diagnosis
1.Lumbar disc herniation
It mostly occurs in middle-aged and young people, with a history of lumbar injury and sprain. Pain is often relieved after rest, and some patients have claudication and scoliosis changes. Factors that increase abdominal pressure (such as coughing and sneezing) make the symptoms worse. The straight leg raise test of the affected limb is positive. A positive strengthening test may be associated with a weakened Achilles tendon reflex and weakness in extending the first toe. The tingling sensation in the skin of the lateral calf and lateral foot is diminished. CT, MR and spinal canal imaging may reveal herniation of the nucleus pulposus into the spinal canal. It is worth mentioning that. It is important not to simply misdiagnose a herniated disc as a herniated disc when there is an asymptomatic intervertebral disc in combination with an epiglottic nerve entrapment.
2.Pear-shaped muscle syndrome
It is common in male young adults, with pain in the buttocks, which may radiate to the whole lower limb. Numbness in the calf and foot, limited pressure pain in the hip radiating to the posterior femur, the posterior part of the boat and the sole of the foot. There is pressure disease along the sciatic nerve cocoa: electromyography suggests signs of nerve damage such as prolonged latency and fibrillation potentials. Pear-shaped muscle syndrome is out of the pear-shaped muscle due to the detrusor variation or trauma, post-activity strain and other reasons caused by edema hypertrophy, degeneration and contracture of the pear-shaped muscle, so that when the prone position relaxes the hip, can be touched in the middle of the arm transverse stripes harder or bulging pear-shaped muscle, local pressure pain is obvious. Restriction of hip internal retraction and internal rotation and aggravation of pain.
3.Third lumbar transverse synostosis syndrome
Preferably in young adults engaged in manual labor. There is a history of lumbar trauma. The main symptom is lumbar pain, which may radiate downward along the thigh. Rarely, it may involve the lateral side of the calf. The symptoms are not aggravated by an increase in abdominal pressure. There is significant pressure pain at the tip of the transverse process of the third lumbar vertebra. Localization is fixed. It is a characteristic feature of the disease, and gluteal muscle atrophy is seen in the advanced stage. This point has diagnostic significance. Tension of the internal femoral retractors is evident in some patients. This is due to stimulation of the posterior branch of the nerve root from L1-L5. This is due to stimulation of the posterior branch of the nerve roots from L1-L5, which reflexively causes spasm of the intramedullary muscles. On physical examination, an elongated lumbar transverse process can be palpated, and on radiography, an elongated transverse process of the third lumbar vertebra is found. Lidocaine closure of the third lumbar transverse process is performed. The pain disappears immediately and is a useful method of identification.
4.Acute lumbar sprain
The movement is not coordinated when carrying heavy objects or too much weight. After the injury, the lumbar region is very first. It is persistent. Aggravated after activity. The symptoms are aggravated when the intra-abdominal pressure increases. Stiffness of the lumbar region and spasm of the erector spinae. Significant restriction of lumbar movement. When the interspinous supraspinous ligament is injured, the interspinous process and the upper part of the spine are obvious pressure pain.
5.Acute lumbosacral joint injury
Hip pain after hip sprain. Difficulty in walking. There is pressure pain along the sacroiliac joint space. Positive “4” test. Generally no radiating pain in the lower limbs. No skin sensory disturbance. The pain increases when the knee or hip is flexed in a flat position.
V. Treatment
1. Nerve block: lidocaine 5ml + tretinoin 2ml injected at the pain point.
2. Surgical treatment: gluteal epicutaneous nerve release.